Objectives: Racial disparities in healthcare use for severe trauma cases, where clinical decision-making may be guided exclusively by patients’ acuity, is not well documented. Our study compared healthcare utilization following Gustilo III tibial fractures.

Methods: Patients within IBM® MarketScan® Medicaid database with Gustilo III tibial fracture (date of surgery = index) from 10/1/2015 to 12/31/2020 and ≥ 6 months of continuous enrollment pre-index were identified. Exclusion criteria included: polytrauma, amputation at index, fractures pre-index, race other than Black or White. Variables included patient demographics, comorbidities (Elixhauser Index (EI)), procedural characteristics (surgery type, implant type used). Black vs White patients were matched using propensity scores on age, gender, surgical procedures and comorbidities. Outcomes included post-surgical treatment (medication use, reoperations) and complications (infection, nonunion) up to 2 years post-index. Chi-square tests and survival analyses (Kaplan-Meier and Cox regression) were conducted.

Results: 694 matched patients were analyzed [37.0% female, average age 34.6 (standard deviation SD: 17.1), 23.8% <19 years, average EI 1.5 (SD: 2.1)]. 35.7% were treated with internal fixation, 38.3% external fixation, and 30.6% intramedullary nails. While not significant, Black patients were slightly less likely to have a reoperation but more likely to have complications compared to White patients (24-month rates for: reoperations = 46.0% for Whites and 42.4% for Blacks, p=0.28; deep infection = 15.3% for Blacks and 11.7% for Whites, p=0.48; nonunion=24.6% for Blacks and 19.8% for Whites, p=0.38). White patients were significantly more likely to be prescribed antidepressants vs Black patients (Patients with ≥ 1 prescription by 24-months: 43.9% White, 29.2% Black, difference: 14.7%, p= 0.01). Differences in prescriptions for strong opiates and antibiotics were not significant.

Conclusions: Rates of deep infection and nonunion trended higher, while reoperations trended lower, in Black vs White patients with Gustilo III fractures. Significant differences were observed in prescription patterns for depression.